Accounting for Health: Economic Practices and Medical Knowledge, 1500–1970

Chris Sirrs

How do countries know how much they are spending on health care? What proportion of this money comes from the public sector, and what proportion is private – for example investment in hospital facilities by private organisations, or out-of-pocket spending by households? Often, figures are banded around by the media, politicians and interest groups without much thought about how they are produced. Moreover, one country’s health spending is often compared to another with little appreciation of the fundamental differences between their health systems.

For over fifty years, there have been various attempts by international organisations to produce a comparative basis for national health spending. Amid concerns about the rising costs of medical care under social security systems, in 1959 Laura Bodmer, an official in the International Labour Organisation penned The Cost of Medical Care, a ground-breaking report comparing health spending in 14 developed economies. Four years later, the health economist Brian Abel-Smith pioneered an ‘international language of health-service finance’ that could be used to classify and compare health spending. The OECD produced a health database for its member states from the 1980s. However, it is only comparatively recently that a ‘system of health accounts’ has been developed to systematically tabulate health expenditures worldwide, and even today, international health accounting is fraught with methodological difficulties: many countries have yet to produce national health accounts according to this agreed framework, meaning that the World Health Organisation is forced to provide ‘best estimates’.

These issues are currently being studied by Chris Sirrs in his contribution to a new working group of historians organized by the Charité – Universitätsmedizin in Berlin. Part of a wider European Research Council-funded project on the use of paper technology in medicine, ‘Accounting for Health’ explores the history of economic and accounting practices in medicine, ranging from the household economy of early hospitals, to the recording of transactions in physicians’ notebooks and the administration of smallpox vaccination. The aim of the working group is to produce a new collective volume on health accounting, and Chris’s contribution to the volume will be distinctive insofar as it is international in scope, more recent in historical focus, and crosses the paper-digital divide (the WHO’s online Global Health Expenditure Database records the health spending of all 194 WHO member states).

Fellow participants include: Barry Doyle, University of Huddersfield; Theodore Porter, University of California, Berkeley; Andrea Rusnock, University of Rhode Island; Michael Stolberg, University of Würtzburg; and Andrew Mendelsohn, Queen Mary, University of London. ‘Accounting for Health’ is organised by Axel C. Hüntelmann and Oliver Falk. Further meetings of the working group will be held in December 2016 and spring 2017.

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